AB0662 Elevated fecal calprotectin in early systemic sclerosis
Authors: V. Hamberg, J. K. Wallman, E. Mogard, E. Lindqvist, T. Olofsson, K. Andréasson
Journal: Annals of the Rheumatic Diseases (2022)

Background Gastrointestinal (GI) morbidity is prevalent in systemic sclerosis (SSc), causing a reduction in quality of life and increased mortality, but has been difficult to assess objectively [1]. Elevated levels of fecal calprotectin (F-cal), a biomarker of GI inflammation, has previously been observed in patients with SSc [2]. F-cal has not been explored in early SSc and its diagnostic potential in the classification of SSc has not been studied. Objectives Our objectives were; 1) study F-cal levels in early SSc; 2) investigate the discriminatory power of F-cal; 3) explore F-cal in relation to GI features of SSc. Methods Consecutive referred patients with suspected new-onset SSc without concurrent non-SSc GI disease were invited to this study. Patients were classified as SSc if meeting ACR-EULAR criteria, or SSc mimickers if they did not. GI symptoms and use of NSAID or PPI was noted. F-cal was measured and levels &gt;50ug/g were classified as elevated. F-cal was also measured in age- and sex matched controls without rheumatological disease. Results Of 137 patients, 92 were classified as SSc and 45 as SSc mimickers. Elevated F-cal was significantly more common in SSc patients compared to the control group (38% vs 7.3%; p &lt; 0.001) but not compared to the SSc mimicker patients (38% vs 31%; p = 0.427). The median F-cal level was higher in SSc patients compared to controls (35 µg/g vs ≤30 µg/g; p ≤ 0.001) but not compared to the SSc mimicker patients (35 µg/g vs ≤30 µg/g; p = 0.248). Elevated F-cal was not associated with any GI symptoms. Elevated F-cal was more common in patients who used PPI (OR 7.14; 95% CI 2.56-29.93; p &lt; 0.001). Conclusion In this study, we demonstrate that elevated levels of F-cal are prevalent already in the early stages of SSc. These results are in line with previous data suggesting that GI involvement may be present in early SSc. Table 1. Frequency of GI features and association to F-cal elevation (n = 92) GI features (n, %) Normal F-cal, n = 57 Elevated F-cal, n = 35 Odds Ratio (95% CI) Dysphagia 19 (35%) 12 (34%) 0.99 (0.41-2.41) Reflux symptoms 33 (59%) 23 (68%) 1.46 (0.60-3.56) Fecal incontinence 9 (16%) 3 (8.6%) 0.50 (0.08-2.22) Patient-reported involuntary weightloss 11 (20%) 8 (23%) 1.21 (0.43-3.39) Dilated esophagus on HRCT 8 (16%) 8 (28%) 1.95 (0.64-5.94) NSAID use 12 (21%) 6 (17%) 0.78 (0.26-2.30) PPI use 23 (40%) 29 (83%) 7.14 (2.56-19.93) Figure 1. F-cal measurements by group. Median value represented by horizontal bar. References [1]Frantz C et al. Impaired quality of life in systemic sclerosis and patient perception of the disease: A large international survey. Semin Arthritis Rheum 2016;46:115-23. [2]Marie I et al. Fecal calprotectin in systemic sclerosis and review of the literature. Autoimmun Rev 2015;14:547-54. Acknowledgements This study was funded by the Anna-Greta Crafoord Foundation, the Swedish Rheumatism Association, Stiftelsen Ulla och Roland Gustafssons Donationsfond. Disclosure of Interests Viggo Hamberg: None declared, Johan K Wallman Consultant of: Consultant of AbbVie, Amgen, Celgene, Eli Lilly, Novartis., Grant/research support from: Research support from AbbVie, Amgen, Eli Lilly, Novartis, Pfizer., Elisabeth Mogard Consultant of: Consultant of Novartis, Elisabet Lindqvist: None declared, Tor Olofsson Consultant of: has performed consulting tasks for Merck Sharp &amp; Dohme and for Eli Lilly, Kristofer Andréasson: None declared